Provider Demographics
NPI:1043627821
Name:BALICH, ALEXANDRIA MARIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDRIA
Middle Name:MARIE
Last Name:BALICH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1636 16TH ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-6356
Mailing Address - Country:US
Mailing Address - Phone:720-546-3575
Mailing Address - Fax:
Practice Address - Street 1:1636 16TH ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-6356
Practice Address - Country:US
Practice Address - Phone:720-546-3575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-14
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO002031211223G0001X
IL019029829122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist